COEUR d'ALENE - State legislators and health-care officials from Kootenai County have varying premonitions of how the Supreme Court's decision on government mandated health coverage will affect Idaho.

Rep. Vito Barbieri, R-Dalton Gardens, believes the financial impact on the state will be draining, he said.

"The fact is this will add to Idaho's overall burden hugely," Barbieri said on Thursday. "It's going to be very difficult for Idaho to afford this, even if we can figure out how to raise taxes appropriately so we can afford it."

Barbieri, who led efforts to nullify the federal health care overhaul last year, was at a loss over whether legislators could wage another battle.

"Certainly the state has no power to stop the federal government from taxing," he said of the court's declaration that the mandate falls within Congress' authority to lay and collect taxes. "I'm not sure the state has any power or authority to avoid this intrusion."

Sen. Jim Hammond didn't have higher hopes.

"If you take something to the Supreme Court and you lose, I'm not sure what else you can do," said Hammond, R-Post Falls and a former member of the Health and Welfare committee.

He expects implementation will be largely left up to the states, however, which will provide opportunities to quell impacts.

"As much as we can in Idaho, we'll try to minimize that," he said.

Hammond reasoned that the state could end up doing away with Medicaid altogether, though he doesn't see that as a budget savings.

"It will be replaced by the new Obamacare, which could be even more costly," he said of the law's coverage of everyone, not just the low income. "It's spreading a wider swath than Medicaid."

Sen. John Goedde, R-Coeur d'Alene, said he expects Gov. Butch Otter might call a special legislative session to work on a state health insurance exchange, which the legislature deferred action on last session.

"I hope we don't find ourselves in the position we'll have to default to the federal exchange," Goedde said. "We would have no regulation. We would have to do whatever the federal carriers mandate. And typically, Washington has been a lot more liberal on granting benefits than local states, especially Idaho."

Himself licensed to sell health insurance, Goedde also worries that Idaho-based insurance companies will be at a disadvantage, competing against national carriers in the exchange.

"I can tell you for a fact that Washington, D.C., doesn't care what happens to health insurance companies in the state of Idaho," Goedde said. "We're small potatoes."

Republican Rep. Marge Chadderdon said she hopes that states won't be as affected by the federal health-care law as had been previously expected.

"I understand that there's much that for states like Idaho, we won't have to comply with some of it," the Coeur d'Alene lawmaker said, adding that she is still analyzing the court's decision.

Her greater concern is how the general economy will fare, she said.

"I do know it's going to take money out of the economy, when everyone's going to have to have insurance, whether they want it or not," Chadderdon said. "It's going to affect our everyday economy, when those dollars won't be used to purchase something else."

Health careofficials offer mixed opinions

n "When we developed Kootenai Health's strategic plan, we assumed that the Affordable Care Act would remain in place," said Jon Ness, Kootenai Health CEO, in a prepared statement. "The Supreme Court's decision allows us to stay the course with our plans.

"While the Supreme Court's decision leaves virtually all of the Affordable Care Act's provisions in place, many practical challenges, including the upcoming federal and state elections, may significantly impact or slow implementation of the federal act."

n Lora Whalen, Panhandle Health District director, said The Affordable Health Care Act will improve access for people who can't afford health care now, "and that's good."

"It'll raise the demand for health care. As for the impact on PHD, we'll have to wait and see. PHD doesn't provide acute care, and there are so many unanswered questions regarding the health-care act at this point," she said.

n Vaughn Ward, CEO of the physician-owned, for-profit Northwest Specialty Hospital in Post Falls, said the act is a step toward socialized medicine and is a hit on free market competition.

"While I have fought for and support our great nation and our system of government, I am disappointed by the Supreme Court's ruling," said Ward, a veteran who fought in Iraq. "This is a major step in the direction of a socialized health-care system in the U.S., which I believe will adversely effect the quality, timeliness and accessibility we currently enjoy."

n Andrea Thomas, spokeswoman for the North Idaho Health Network that consists of about 270 physicians and community-owned facilities such as Kootenai Medical Center, Bonner General and Shoshone Community Hospital, said the decision validates the need for change.

"The ruling reinforces North Idaho Health Network's decision to transform the way health care is designed, delivered and experienced locally," Thomas said. "The ruling clears the skepticisms surrounding the permanency of payment reform and the need for the medical community to re-evaluate the current care delivery model."

n Mike Baker, CEO of Dirne Community Health Center, said passage of the act "is a very positive step for the patients in our community living without health insurance."

Those patients include middle-class families who are unable to purchase the health insurance from their employer to the patients that Dirne serves in the homeless program.

"We hear time and time again that people are delaying health care because of the financial shortfalls that folks are facing," Baker wrote. "We have seen the devastating effects of delaying health care - lives are cut short, the workforce becomes less reliable and the overall quality of life in a community begins to decrease."

He said Dirne applauds the efforts by both sides of the political aisle to evaluate the state of the health-care system. At the same time, Baker said Dirne questions about how the legislation will look now that they have changed the requirements for the Medicaid program.

"As it stands, it looks like everyone will face a penalty if they do not buy health insurance, but most people anticipate that the premiums will still be too costly for patients that would have qualified for the Medicaid subsidy," Baker said. "Would these patients now have to pay a penalty and still not have health insurance?"

Dirne is working to provide local solutions to local problems. It launched a health-care membership program that small business can utilize for employees.

For less than $150/month a family of four can have access to the basic health care that they need.

"We understand that the new legislation creates concern because of the huge increases in federal spending. We hope that common sense will ultimately prevail and that we will have a system that is affordable, accessible and accountable in our community."